Reimbursement
$26.05
Threshold
10m
2026 Status
Active
What is CPT Code 99470?
CPT 99470 is defined as: Remote physiologic monitoring (RPM) treatment management services provided by clinical staff, physicians, or other qualified health care professionals during a calendar month. This code requires at least 10 minutes but no more than 19 minutes of time spent on the cumulative review and analysis of patient physiologic data and the management of the treatment plan. At least one interactive communication (e.g., phone or video call) with the patient or caregiver during the month is mandatory.
This code is primarily used for RPM services. It falls under the category of Remote Patient Monitoring (RPM) and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0.31
Physician Effort
PE (Non-Fac)
0.45
Practice Expense
Malpractice
0.02
Risk Factor
Total RVU
0.78
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Strategically exempt from the -2.5% efficiency adjustment. CMS continues to incentivize remote monitoring as a tool for longitudinal care management.
granular reimbursement
The 2026 rule emphasizes 99470 as a way to capture clinical effort for lower-acuity patients who do not reach the 20-minute threshold of 99457.
conversion factor
Utilizes the 2026 Non-QP rate of $33.40.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
time threshold
Requires a minimum of 10 minutes and a maximum of 19 minutes of cumulative time per calendar month.
interactive communication
At least one synchronous (live) communication with the patient or caregiver is mandatory to bill 99470. Asynchronous data review alone is not sufficient.
clinical staff eligibility
Unlike RTM, RPM treatment management (99470) can be performed by clinical staff (MA, LPN, RN) under the general supervision of a physician or QHP.
frequency
Reported once per calendar month.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Exempt from the mandatory -2.5% efficiency cut. Interactive communication is a mandatory component.
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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